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. <br /> --_ u_ - <br /> ..----�-- ---�-----._ �--- - ----`--------------- ------- � <br /> f � � . <br /> '"� APPLI(3ATION FOR PUBLIC WORKS PERMIT <br /> � TYGe or print cleady with ink , <br /> PRESS HApD•YOU ARE MAKING COPIES g L a . <br /> PUBLIC WORKS PERMIT NO. <br /> EVERETT,WASHINGTON BLDG. DEPI'. NU. � <br /> 0"OWNER ❑ AGENT DATE ���� -8Z - <br /> APPLICANT/FIRM REPRESENTED � `� S• GC�i/�/pvyr S <br /> ADDRESS .�� ��Or/CI.�? �/' CITY �(�P/P7�L TELEPHONE �J 3 �G S� , <br /> NEREBY APPLIES FOR PERMISSIQN TO �.5 �S.��G�T ��' � ✓e r�c.� <br /> AT THE FOLLOWING L(JGATION O � � Z- �O f i ct cti. �r. <br /> Attach tive(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicable: <br /> • Property lines and street identity. * Topographic channAs requiring cuts and fills ' <br /> * Outline and dimensions ot existing and other than normal foundation. <br /> proposed structures. * On-site drainage systems when required. <br /> * Existing ano proposed utilities. • Erosion control methods when required. <br /> * Centerline of abutting right of way. * No arrow // <br /> �A , _ <br /> Signature o:App icant <br /> PUBf�IC WORKS PERMIT <br /> CONDITIONS: <br /> � . . . . . . . . . . . , <br /> ; �. � �.a-�r �or�io.-. o� -��+ e cE(�Jfwa w'� -�-1,,:. -1-� e �tib��'� . � <br /> � _ _ . . j2�y��'- OT - lNa� ���s.1 be �a�ed , . . . . . � <br /> I � Z:--3'�- ,fi0 . �r//O��vT`: u.�2C . ___'_. _; <br /> �_. _ : : �-XIST/,U4 D2I UE /S f=SPh� : : ; : : ' <br /> �__ : :, :. : : : ; : : : : . <br /> ; _ . �� � . <br /> � . . , } . . ; . ; i . <br /> � <br /> .� � .. i.-.... ....-_�� ' .._-_ . __.+ . �_.. _ _ . . .. _ _. � . ._ _�.-Y .�-. <br /> - . . . . . ( . . . . . . i . . . . . ' . .. . . . . r , . . . . . � . . � i . � . . . . . . . <br /> _ .. . • . . . . ' . . . . . . . . . 4 . . . �. . .. . . . . . . . . . . . . . . . � . . . . . . . . . � . . <br /> , . . . ! . . . f , . . ' . . . . ; . . . . : . . . , . . : . . . . . <br /> � . ; , <br /> , <br /> ---. _ __ , - -- ,. .___t_ __ �. ------ - - .. . . . . . . . . . . . . . . <br /> _ . . .-- . . . . _ ; <br /> : . . . : . . : . : . : : . : . . . . . . . . : � . <br /> . . . . . . . . . . . . . . i . . . . <br /> . <br /> ___.__, .. _.._ .__---_:__....__-._ __-�.._-_,--. . <br /> j . . . �. . . . I . . : . . _ . . . . . . . . , Thn undersignetl owner hereby agrees to hold and save harmless <br /> . . . . , . . �. . . . . �. . . . . . , ihe Ciry of Evarett trom any antl au cL�.ims for damages, cosis, <br /> �� erpenses,or causes of aclion ihat mey arisa because ol lnslellation <br /> ' . . . . . . . . . . . . <br /> {--• �� � � � � � � � � - - � � � - � - � � � and maintenance ol ihe improvement or other riph4ol-way use <br /> � � � � � � � - . - � hereto applied for and luriher agrees to remove seme upon notie0 <br /> � '� � � Irom Ihe Cit and tn re lace public <br /> � � � � � � � y p propetly dameged thereby. <br /> APP�R�+ S- b' L _J <br /> �NSTFUCTION � /DATE AC aQWLEDGE E OF�ONGi ' <br /> l�( e,� 3-Z�� -�33 '�,Y� C.��L� /-2S-�Z. <br /> APPROVED AS CONST, CTED DATE SIGNATURE OF APPLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR pOST ON CALL FOR INSPECTION <br /> 259-8811 <br /> � �. EXPIRATION � �s 8'3 JOBSITE 24HRS. BEFORECONSTRUCTION <br /> i � - --- ------- — .�. <br />